慢性双分支阻滞的意义及预后

The significance and prognosis of chronic bifascicular block.

作者信息

Wiberg T A, Richman H G, Gobel F L

出版信息

Chest. 1977 Mar;71(3):329-34. doi: 10.1378/chest.71.3.329.

DOI:10.1378/chest.71.3.329

Abstract

The clinical course of 303 patients with bifascicular block was reviewed. Initially, 62% of the total group had evidence of heart disease. The highest frequency of heart disease was in patients with left bundle-branch block and first-degree atrioventricular block (78% or 22/28), while the lowest was in those with right bundle-branch block and left axis deviation (56% or 55/98). During the subsequent clinical course the occurrence of cardiovascular morbidity was greatest in patients who had left bundle-branch block and heart disease (55% or 49/89). Complete heart block occurred in only 11 patients. The highest incidence of complete heart block occurred in right bundle-branch block and left axis deviation when associated with heart disease, but the annual rate was only 4%/yr. Mortality was highest in those with left bundle-branch block, first-degree atrioventricular block, and left axis deviation (43%/yr). A one-year mortality of 65% (11/17) was noted for patients who had bifascicular block prior to the time of acute myocardial infarction.

摘要

回顾了303例双分支阻滞患者的临床病程。最初，全部患者中有62%有心脏病证据。心脏病发生率最高的是左束支传导阻滞合并一度房室传导阻滞的患者（78%，即22/28），而最低的是右束支传导阻滞合并左轴偏移的患者（56%，即55/98）。在随后的临床病程中，左束支传导阻滞合并心脏病的患者心血管疾病发病率最高（55%，即49/89）。仅11例患者发生了完全性心脏传导阻滞。完全性心脏传导阻滞发生率最高的是右束支传导阻滞合并左轴偏移且合并心脏病的患者，但年发生率仅为4%。左束支传导阻滞、一度房室传导阻滞合并左轴偏移的患者死亡率最高（43%/年）。急性心肌梗死发生前就有双分支阻滞的患者一年死亡率为65%（11/17）。